<?xml version="1.0" encoding="UTF-8" ?>
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema">
<category>
  <categoryId>1</categoryId>
  <categoryName>Cognitive impairment, dementia, and Alzheimer's disease</categoryName>
    <item>
      <id>1</id>
      <title>What is cognitive deterioration?</title>
      <description>
        Cognitive impairment consists of the impacts of cognitive domains or superior cerebral functions, which are generally divided into attention, executive functions, memory, language, and visual perception. Age alone has a negative effect on these functions, but not to the extentthat they disrupt everyday life (work, personal care, managing finances, etc.). Depression, medication, infection, dehydration, and vascular or neurodegenerative disease are, among others, some factors that can lead to cognitive impairment. When one or more cognitive domains are more affected than should be at the age of the patient (with respect to his or her previous capacity), but their deterioration has no significant impact on everyday activity, it is known as Mild cognitive impairment (MCI). People who suffer from mild cognitive impairment are at risk of developing dementia, in the same way that people with vascular problems are at risk of having a heart attack.
      </description>
    </item>
    <item>
      <id>2</id>
      <title>What's dementia?</title>
      <description>
        Dementia is a disorder where there are at least two cognitive domains affected beyond what might be expected from normal aging and represents a decline from previous levels of functioning and performing. This interferes with the ability to function at work or at usual activities. Usually this disorder develops slowly and progressively, lasting more than six months.
		The most frecuent causes are neurodegenerative diseases such as Alzheimer's disease, Dementia with Lewy bodies or frontotemporal dementia. These diseases affect the brain by killing neurons in a gradual and progressive manner. An other common cause is cerebrovascular disease (eg. lacunar or cortical stokes). However, it's always important to rule out other causes. 
		The most important risk factor is age. Therefore, dementia is unlikely to develop before the age of 50 but affects aproximately 10% of people over 65 years old.
      </description>
    </item>
    <item>
      <id>3</id>
      <title>Alert signs</title>
      <description>
        &lt;b&gt;If you see any of the following changes:&lt;/b&gt;&lt;br /&gt;
        •	Memory problems which affect everyday activities&lt;br /&gt;
        •	Problems planning tasks or solving problems&lt;br /&gt;
        •	Difficulty with everyday tasks or abandonment thereof&lt;br /&gt;
        •	Repeatedly confusing dates and places&lt;br /&gt;
        •	Difficulty speaking or writing&lt;br /&gt;
        •	Losing things&lt;br /&gt;
        •	Decreased social interaction&lt;br /&gt;
        •	Changes in personality or behavior&lt;br /&gt;
      </description>
    </item>
    <item>
      <id>4</id>
      <title>What is Alzheimer's Disease?</title>
      <description>
        Alzheimer's disease is the most common form of dementia, representing 70% of instances of dementia in people over the age of 65. The exact cause of the illness is not known, but it is associated with the presence of particular lesions: Neurofibrillary Tangle (NFT) and Senile Plaque (SP). People who suffer from the disease display a higher quantity of these lesions in their brains, progressively damaging neurons. It is estimated that this process takes 10-20 years until symptoms of dementia become apparent.
      </description>
    </item>
    <item>
      <id>5</id>
      <title>Is Alzheimer's Disease Hereditary?</title>
      <description>
        Although a history of the illness in the family increases risk, less than 5% of cases are accredited to hereditary genetics. The majority of cases are random. The genes most associated with the disease are amyloid precursor protein (APP) and  presenilin-1 and presenilin-2 (PS1 and PS2). The genetic cases tend to start early (before the age of 50). Other genes like APOE 4 carry the most risk in developing the illness, but many people who have said gene do not develop it.
      </description>
    </item>
</category>
<category>
  <categoryId>2</categoryId>
  <categoryName>Diagnosis of Alzheimer's Disease</categoryName>
    <item>
      <id>6</id>
      <title>How is Alzheimer's diagnosed? </title>
      <description>
        There is no absolute method or study for the diagnosis of Alzheimer's disease. Through evidence produced by a medical evaluation by a qualified profesional (generally a neurologist, psychiatrist or geriatrician), a full laboratory, a cognitive evaluation or screening, and studying brain scans (computer-rendered tomography or MRI), we can apply process of elimination to rule out other causes of dementia. If a conclusive diagnosis has still not been found, studies of further complexity are required.
      </description>
    </item>
    <item>
      <id>7</id>
      <title>Why is it important for the patient to know the diagnosis?</title>
      <description>
        Aside from the fact that it is a patient's right to know their diagnosis (Law 26.529), in the early stages of Alzheimer's disease the patient retains to a large extent their ability to understand and reason. Being aware of their illness allows the patients to make decisions about their future.
      </description>
    </item>
    <item>
      <id>8</id>
      <title>Can you know if you are going to develop this disease in the future?</title>
      <description>
        There is no diagnostic study that is able to predict, with any degree of certainty, if a person will suffer from Alzheimer's disease. There are certain known factors that increase susceptibility, of which the most significant are the presence of MCI and old age. In healthy people it is impossible to know if someone will develop the disease unless they have one of the previously mentioned genes.
      </description>
    </item>
    <item>
      <id>9</id>
      <title>Can it be prevented? </title>
      <description>
        There are certain known factors that reduce or slow the process of the disease: greater cognitive reserve (linked to intellectual development, e.g. years of education), a healthy diet, regular physical activity, and control of vascular risk factors (high blood pressure, diabetes, high cholesterol, obesity, sedentary lifestyle, smoking etc.)
      </description>
    </item>
</category>
  <category>
    <categoryId>3</categoryId>
    <categoryName>Consequences of Alzheimer's disease</categoryName>
    <item>
      <id>10</id>
      <title>How does Alzheimer's disease affect those who suffer from it?</title>
      <description>
        The neuron damage brings about changes in cognition and conduct, which invariably have a detrimental effect on everyday functioning.
        The cognitive symptoms are typically problems with memory, although they also tend to affect language (making oneself understood as much as understanding others) and visual perception (patients often have trouble identifying things without having visual problems) among others.
        Problems with conduct are very common, and generally arise in the disease's advanced stages. Loss of motivation and initiative, as well as depression, are the most common changes. Sleep disorders, irrititability, aggression, anxiety, delusion and hallucinations are some other changes that may be seen.
        Effects on everyday functioning manifest themselves in a patient's difficulty in or inability to carry out everyday activities (work, free time, transport, managing finances, etc.) which often leads to the patient's neglect of said tasks altogether. The advanced stages of the disease can even lead to the patient's inability to perform basic tasks, such as getting dressed, personal hygiene, and feeding themselves. The symptoms become more evident with the gradual progression of the disease.&lt;br /&gt;&lt;br /&gt;
        &lt;b&gt;Advice for dealing with memory problems:&lt;/b&gt;&lt;br /&gt;
        •	Do not correct the person every time they make a mistake&lt;br /&gt;
        •	Help them to find the words to express themselves, but do not speak for them&lt;br /&gt;
        •	Do not say ?I already told you that? or ?Don?t you remember??&lt;br /&gt;
        &lt;b&gt;Advice for dealing with communication problems:&lt;/b&gt;&lt;br /&gt;
        •	Maintain eye contact&lt;br /&gt;
        •	Address the person by name&lt;br /&gt;
        •	Pay attention to the tone and volume of your voice as much as to body language&lt;br /&gt;
        •	Encourage the person into reciprocal conversation&lt;br /&gt;
        •	Do not distract or interrupt them&lt;br /&gt;
        •	Ensure that you appear patient and understanding&lt;br /&gt;
        •	Hold their hand&lt;br /&gt;
        •	Give simple, step-by-step instructions&lt;br /&gt;
        •	Do not speak about the person as if they were not there&lt;br /&gt;
        •	Ask questions with 2 options (eg. Would you like chicken or beef for lunch?)&lt;br /&gt;
      </description>
    </item>
    <item>
      <id>11</id>
      <title>What are the different stages of the disease?</title>
    <description>
      Generally the process of the disease's development is divided into 3 stages, from the patient's diagnosis onwards. The initial (or mild) phase is characterized by cognitive problems (mainly in memory) that affect the patient's normal performance without noticeable changes in conduct. The patient needs help but is for the most part independent. In the moderate stage there are more clear disruptions that affect some of the patient's cognitive command (language and the ability to make decisions) on top of their conduct. They need assistance with the majority of everyday tasks and cannot manage by themselves. In the severe (or terminal) stage their dependence is absolute, even with everyday activities such as feeding themselves and personal hygiene. In this stage there are frequently medical complications.&lt;br /&gt;&lt;br /&gt;
      &lt;b&gt;Advice for adapting everyday activities to the changes brought about by the disease:&lt;/b&gt;&lt;br /&gt;
      •	Be flexible and patient&lt;br /&gt;
      •	Include the person in said activities&lt;br /&gt;
      •	Avoid correcting them unless necessary&lt;br /&gt;
      •	Help them to maintain as much autonomy as possible&lt;br /&gt;
      •	Give simple instructions&lt;br /&gt;
      •	Simplify, organize and supervise&lt;br /&gt;
      •	Take into account the person's preferences and skills&lt;br /&gt;
      •	Pay attention to what they enjoy doing&lt;br /&gt;
      •	Concentrate on the process rather than the result&lt;br /&gt;
      •	Help to initiate the activities&lt;br /&gt;
    </description>
    </item>
    <item>
      <id>12</id>
      <title>How does Alzheimer's disease affect patients? behavior?</title>
      <description>
        Problems with conduct are very common, and generally arise in the disease's advanced stages. Loss of motivation and initiative, as well as depression, are the most common changes. Sleep disorders (e.g. insomnia), irritability, verbal or physical aggression, anxiety or unrest (e.g. walking about the house at night with no purpose), delusion (e.g. wrongly thinking things having been stolen from them) and hallucinations (e.g.seeing people that are not there) are some other changes that may be seen. These symptoms are part of the illness and in many cases represent a marked change in the former behavior of the person. Generally these problems increase due to the lack of structured activities in the everday life of the patient.&lt;br /&gt;&lt;br /&gt;
        &lt;b&gt;Advice for dealing with problems with conduct:&lt;/b&gt;&lt;br /&gt;
        •	Build a daily routine so that the person can know what is going to happen&lt;br /&gt;
        •	Make them feel cared for&lt;br /&gt;
        •	Don?t argue or want them to make them see reason&lt;br /&gt;
        •	Concentrate on feelings more than words&lt;br /&gt;
        •	Use humor when possible&lt;br /&gt;
        •	Try not to appear angry&lt;br /&gt;
        •	Use music, singing or talking to entertain them&lt;br /&gt;
        •	Do not overstimulate (decrease noise level in the environment, if possible)&lt;br /&gt;
        •	Simplify tasks, breaking down steps one by one&lt;br /&gt;
        •	Create a safe and comfortable environment&lt;br /&gt;
      </description>
    </item>
    <item>
      <id>13</id>
      <title>What can I do when a person with Alzheimer's disease has trouble sleeping?</title>
    <description>
      Up to half of Alzheimer's sufferers have trouble sleeping (insomnia, oversleeping, sleeping in the he daytime rather than at night, etc.) The most important thing to counter these problems is to adopt an appropriate and well managed sleep cycle by keeping the person active during the day, avoiding naps, and keeping the house well lit with natural light during the day. Luminotherapy and melatonin supplements can also help. Medication prescribed for sleeping offers no clear benefit and can be harmful.&lt;br /&gt;&lt;br /&gt;
      &lt;b&gt;Advice for helping you and your family member relax:&lt;/b&gt;&lt;br /&gt;
      •	Do physical exercise during the day&lt;br /&gt;
      •	Avoid napping&lt;br /&gt;
      •	Keep a routine full of daily activities&lt;br /&gt;
      •	Avoid coffee or tea&lt;br /&gt;
      •	Stick to the planned bedtime&lt;br /&gt;
      •	Expose him/her to sunlight&lt;br /&gt;
    </description>
    </item>
    <item>
      <id>14</id>
      <title>What can I do when a person with Alzheimer's disease has no initiative or motivation to do anything?</title>
    <description>
      Apathy is the most common symptom in the conduct in sufferer's of Alzheimer's disease and is often linked to or confused with depression. This lack of motivation is part of the disease. An effort must be made to encourage, not insist, that the person to have a routine. Occupational therapy, musictherapy and physical exercise are useful tools to improve this situation.
    </description>
    </item>
    <item>
      <id>15</id>
      <title>What can I do when a person with Alzheimer's disease is sad or cries?</title>
    <description>
      People with Alzheimer's disease will often, at some point, display depressive symptoms. Owing to the intrinsic cognitive problems of the disease, psychotherapy offers no clear advantage. Physical and recreational activity as well as antidepressants are generally the treatment of choice. It is also important to accompany the person when visiting the doctor.
    </description>
    </item>
    <item>
      <id>16</id>
      <title>What can I do when a person with Alzheimer's disease is aggressive?</title>
      <description>
      Although not a frequent symptom, verbal or physical aggresion can be a source of problems and worry in families. In some cases the person's character traits are emphasized in their conduct, but in others their conduct is completely in contrast with their usual way of being. It is important to remember that an aggressive patient is generally so because they feel at unrest (pain, delusion that people want to hurt them, etc.) which they express through aggression. For this reason it is of the upmost importance to remain calm and to try to calm the patient without putting onesself at risk. In cases where the patient may be dangerous, the help of health professionals must be sought urgently.&lt;br /&gt;
        &lt;br /&gt;
        &lt;b&gt;Advice for handling a patient's aggression:&lt;b&gt;&lt;br /&gt;
        •	Recognize potential triggers of aggression (pain, changes in life, fatigue, etc.).&lt;br /&gt;
        •	Assess whether the task is taking its toll on you and whether and, if so , if it affects the patient's mood&lt;br /&gt;
        •	Distract them&lt;br /&gt;
      </description>
    </item>
    <item>
      <id>17</id>
      <title>What can I do when a person with Alzheimer's disease sees things that aren?t there?</title>
    <description>
      Some patients may experience hallucinations, for the most part visual but sometimes those which affect the other senses. If they occur suddenly and appear to affect attention span, it would suggest a clinical problem requiring urgent medical assistance. If the hallucinations are tied to dementia, they tend to occur continuously or intermittently for a prolonged period of time. It is important to remember that people who suffer hallucinations generally perceive them as real, life, meaning any attempt to disprove them can only be unhelpful. However they are not always perceived as threatening, in which case the patient may not require any medication.
    </description>
    </item>
    <item>
      <id>18</id>
      <title>What can I do when a person with Alzheimer's disease believe people are stealing from them or that people want to hurt them?</title>
    <description>
      Psychotic, delirious ideas, and the general disbelief of objective fact can be a symptom of the disease. This inability to correctly perceive reality can be harmful, as patients tend to blame friends, family and strangers alike. As the patient's views are irrefutable, the most important thing is to keep them calm and not reason with them over whether what they are saying is true or not.&lt;br /&gt;
      &lt;br /&gt;
      &lt;b&gt;Advice for dealing with a patient's hallucinations or delirium:&lt;b&gt;
      •	Don't argue or even try to convince them that they are mistaken&lt;b&gt;
      •	Distract them&lt;br /&gt;
      •	Make them feel safe&lt;br /&gt;
      •	Don't get frustrated&lt;br /&gt;
      •	Explain to others that it is part of the illness&lt;br /&gt;
    </description>
    </item>
    <item>
      <id>19</id>
      <title> Why do people with Alzheimer's disease sometimes not realize their difficulties?</title>
    <description>
      In the case of some neurological problems (of which Alzheimer's disease is one) people can display a symptom known as anosognosia. This consists of a patient's inability to notice the existence of his or her disability. It is not a conscious thought, rather an effect of the illness. It is for this reason that this should be work it out during  treatment without causing conflict between the family and the patient.
    </description>
    </item>
    <item>
      <id>20</id>
      <title>What physical problems does Alzheimer's disease cause?</title>
    <description>
      Although not a typical characteristic of the illness, some problems with movement can arise similar to those found with Parkinson's disease (e.g. trembling, stiffness or slowness of movement, reduced facial expression etc.). If these symptoms are particularly noticeable, it eliminates considerations of other illnesses. When the disease reaches advanced stages it can jeopardize a patient's ability to swallow, so much so that they can choke badly and encounter severe problems, such as pneumonia. It is important to take note of whether a patient coughs when drinking or eating and, if so, arrange a medical appointment to assess their swallowing.
    </description>
    </item>
      </category>
  <category>
    <categoryId>4</categoryId>
    <categoryName>Treatment of Alzheimer's disease</categoryName>
    <item>
      <id>21</id>
      <title>What treatment is there for Alzheimer's disease?</title>
      <description>
        There are two ways of treating the disease. The treatment with the best reputation internationally are acetylcholinesterase inhibitors (including donepezil, galantamine and rivastigmine) which are generally the initial medications and memantine. There are also alternative option to pharmacological treatment that include rehabilitation or cognitive stimulation, occupational therapy, audiology, and musictherapy, among others. Nutrition, physical activity and controlling vascular risk factors also play an important role in treatment.
      </description>
    </item>
    <item>
      <id>22</id>
      <title>What are the benefits of treatment for Alzheimer's disease?</title>
      <description>
        There are no treatments that can cure the disease. The treatment's main benefit is the decline of the symptoms, as the disease is unavoidably progressive. Treatment can slow the progress of the disease and can minimize its impact, allowing for a better quality of life.
      </description>
    </item>
    <item>
      <id>23</id>
      <title>Does Alzheimer's disease have a cure?</title>
      <description>
        There is still no cure for the disease as none of the available treatments affect or offset the lesions that cause the disease. There are many investigations dedicated to developing a curative treament.
      </description>
    </item>
  </category>
<category>
    <categoryId>5</categoryId>
      <categoryName>Alzheimer's disease and decisions that affect the family</categoryName>
    <item>
      <id>24</id>
      <title>¿Can people with Alzheimer's disease drive?</title>
      <description>
        The majority of Alzeimer's sufferers should not drive as they pose a great risk to themselves and to others. The deterioration of cognitive functions (principally attention, executive functions and spatial awareness) makes patients prone to accidents. A doctor should be consulted in any case.
      </description>
    </item>
    <item>
      <id>25</id>
      <title>How can I make the house safer for them?</title>
    <description>
      &lt;b&gt;A few tips:&lt;/b&gt;&lt;br /&gt;
      •	Install fire alarms&lt;br /&gt;
      •	Write down emergency and contact numbers in clear view&lt;br /&gt;
      •	Install a circuit breaker&lt;br /&gt;
      •	Lock away: alcohol, medecine, chemicals, weapons and fuel&lt;br /&gt;
      •	Get rid of rugs&lt;br /&gt;
      •	Install handrails in bathrooms and on stairs.&lt;br /&gt;
    </description>
    </item>
    <item>
      <id>26</id>
      <title>Why do I feel that the whole situation is too much for me?</title>
    <description>
      Nothing prepares us for the difficult task of looking after a loved one. The peculiarity of this disease is seeing the physical changes brought about in the person. It is often hard to distinguish between the person's own behavior and that which is affected by the disease. This can make us feel helpless, sad, angry, guilty or confused, all of which are normal emotions in this situation. &lt;/b&gt;&lt;br /&gt;
      &lt;b&gt;Advice for looking after yourself:&lt;/b&gt;&lt;br /&gt;
      •	Become better acquainted with the disease&lt;br /&gt;
      •	Become acquainted with the resources at your disposal which are helpful: family network, disabled permit, etc.&lt;br /&gt;
      •	Go to some workshops or courses on the subject&lt;br /&gt;
      •	Ask for help&lt;br /&gt;
      •	Look after your body through a healthy diet, physical activity and rest&lt;br /&gt;
      •	Stress-relief techniques (e.g. mindfulness)&lt;br /&gt;
      •	Accept change&lt;br /&gt;
      •	Manage your finances and legal matters&lt;br /&gt;
      •	Value yourself&lt;br /&gt;
      •	Talk to a doctor&lt;br /&gt;
    </description>
    </item>
    <item>
      <id>27</id>
      <title>When should one turn to a professional caregiver?</title>
    <description>
      When those family that look after the patient are overburdened by his or her care requirements for any reason, it is important to consider the option of employing a personal caregiver, preferably with experience and training in this particular kind of care. It is advisable that the care is not undertaken by only one person, but rather that the work be shared (e.g. night caregiver, day caregiver or weekend caregiver, etc.)
    </description>
    </item>
    <item>
      <id>28</id>
      <title>When should a person with Alzheimer's disease be institutionalize?</title>
    <description>
      While there are no clear indications as to when a person should be admitted, when it is difficult to maintain the person's care requirements, which can be for different reasons (lack of human resources, inappropriate housing conditions, need for specialist help, etc.), it is best to seek professional help. Health professionals will advise the family on what course of action to take for the good of the patient's surroundings and subsequent wellbeing.
    </description>
    </item>
</category>
</xs:schema>